People living with psychotic illness 2010

Appendix 15. Medication use and psychosocial interventions

Page last updated: November 2011

Medications for mental illness

Psychotropic medications are used to treat the symptoms of mental illness. Those that play an important role in the treatment and management of psychotic disorders and comorbid psychiatric conditions include:
  • antipsychotics used either orally or in an injectable (short or long-acting) form to control the acute symptoms of psychosis and prevent relapse

  • antidepressants used to treat depression which may be an early feature of psychosis or a secondary feature arising in the context of psychosis, as in ICD-10 post-psychotic depression

  • mood stabilisers used to treat mania, including bipolar disorder, and to prevent relapse; they may also be used for treatment-resistant depression or as an adjunct to antipsychotic medications

  • anxiolytics, hypnotics and sedatives used to treat common and non-specific symptoms, such as anxiety, insomnia and restlessness; or used as an adjunct to antipsychotic medication to ameliorate the symptoms of acute psychosis; and

  • anticholinergics used to reduce neuromuscular side effects, such as Parkinson-like movement disorders, associated with the use of antipsychotic medication, particularly typical antipsychotics.
Antipsychotics may be sub-classified as typical (or first generation) antipsychotics, an older form of antipsychotic medication, and atypical antipsychotics, a more recent form.

Typical and atypical antipsychotics are effective in reducing the positive symptoms of psychosis, but are less effective in ameliorating negative symptoms. In general, atypical antipsychotics are less likely to produce neuromuscular side effects (for example, Parkinson-like movement disorders) than typical antipsychotics. However, they have also been associated with weight gain and consequent risk of poor physical health outcomes, especially metabolic disorders such as diabetes type 2.

Clozapine, an early atypical antipsychotic, is often used in cases of treatment-resistant schizophrenia, that is cases that do not respond to other antipsychotic medications.

Appendix Table 15-1. Prescribed medication used in past 4 weeks

Males
(%)		Females
(%)		18-34 years
(%)		35-64 years
(%)		Persons
(%)
Medications for mental health
Atypical antipsychotics: All
76.3
70.7
75.2
73.2
74.0
Atypical antipsychotics: Clozapine
19.9
11.4
16.2
16.6
16.4
Typical antipsychotics
16.0
14.1
12.5
17.2
15.2
Antidepressants
32.5
44.7
31.7
41.6
37.4
Mood stabilisers
24.5
30.1
22.3
30.0
26.7
Anxiolytics, hypnotics, sedatives
15.7
20.7
15.1
19.7
17.8
Anticholinergics
4.7
3.4
3.6
4.6
4.2
Alcohol/Nicotine/Opoid dependence
4.0
2.8
4.5
2.8
3.5
Subtotal on antipsychotics
84.4
77.6
80.6
82.4
81.6
Total in past 4 weeks
91.4
91.9
88.6
93.8
91.6
Total in past year
94.1
94.7
93.5
95.0
94.4
Medications for physical conditions
Cardiovascular
17.1
19.8
7.4
26.1
18.2
Endocrine: Any
10.2
21.4
7.2
20.2
14.7
Endocrine: For diabetes
7.7
8.8
3.1
11.9
8.2
Gastrointestinal
11.5
14.8
6.9
17.2
12.8
Respiratory
4.6
8.0
4.3
7.2
6.0
Blood and electrolytes
3.4
4.9
1.8
5.6
4.0
Neurological
3.4
4.3
2.8
4.5
3.8
Musculoskeletal
3.2
4.5
1.7
5.2
3.7
Genitourinary
0.7
0.8
0.3
1.1
0.8
Total in past 4 weeks
38.5
45.0
27.8
50.9
41.1
Median number of prescribed medications (if using)
2
3
2
3
3
Non-prescribed supplements for mental health
Proportion taking supplements for mental health
20.1
24.5
20.4
23.0
21.9

* Unless otherwise indicated, these numbers relate to prescribed medication use in the past four weeks

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Appendix Table 15-2. Impairments due to medication prescribed for mental health in past 4 weeks

Males (%)Females (%)18-34 years (%)35-64 years (%)Persons (%)
Any medication side effects
76.6
78.5
75.9
78.4
77.4
Moderate/severe impairment in daily life due to medication side effects
30.0
29.8
29.4
30.3
29.9

Appendix Table 15-3. Side effects attributed to medication prescribed for mental health in past 4 weeks

Males (%)Females (%)18-34 years (%)35-64 years (%)Persons (%)
Drowsiness,sleepiness during the day
43.4
46.6
45.0
44.5
44.7
Mouth dry or more watery than normal
37.4
42.5
34.3
43.3
39.5
Increase in weight
33.1
44.0
39.5
36.1
37.5
Inner restlessness
26.5
24.7
24.3
26.8
25.8
Trembling, shaking hand/arm/leg
22.8
25.6
21.2
26.0
23.9
Inability to relax
21.5
19.6
18.9
22.1
20.8
Inability to stand still, desire to move legs, pacing
19.1
19.6
19.4
19.3
19.3
Stiff, tensed muscles
18.3
20.1
16.6
20.8
19.0
Increased dreaming
17.6
20.2
19.0
18.3
18.6
Dizziness or vertigo
16.7
21.5
16.0
20.5
18.6
Trouble with eyesight
16.0
18.8
13.3
20.0
17.2
Unsteady when standing or walking
15.2
19.1
14.2
18.6
16.8
Slowing down of movements
15.5
17.8
14.2
18.1
16.4
Change of interest in sex
16.9
15.2
15.8
16.5
16.2
Nauseous/Feeling sick
14.4
18.3
16.2
15.8
15.9
Constipation
13.9
18.7
12.9
18.0
15.8
Increased sweating
14.8
15.6
13.8
16.1
15.1
Period pain or change in frequency (Females only)
-
12.2
14.6
10.9
12.2
Palpitations
9.8
14.9
10.3
12.9
11.8
Difficulty swallowing
10.2
12.7
9.3
12.6
11.2
Sexual dysfunction
10.2
10.6
9.7
10.8
10.4
Shuffling along
7.8
6.2
5.2
8.7
7.2
Skin rashes
6.3
8.4
5.2
8.6
7.1
Unwanted tongue movement
7.3
6.5
5.7
7.9
7.0
Swollen tender chest
2.9
4.6
3.2
3.8
3.6
Decrease in weight
3.2
3.4
2.8
3.6
3.3

Appendix Table 15-4. Weight gain in past 6 months related to use of medication for mental health

MalesFemales18-34 years35-64 yearsPersons
Mean
10
9
10
9
9
Median
8
8
10
8
8

Appendix Table 15-5. Relief from mental health symptoms due to medication use

Males (%)Females (%)18-34 years (%)35-64 years (%)Persons (%)
A lot
56.7
58.0
53.7
59.7
57.2
A little
28.3
28.0
32.1
25.4
28.2
Not at all
10.4
8.4
9.5
9.6
9.6
Not known
4.6
5.6
4.7
5.3
5.0
Total of those using medications
994
678
685
987
1672

Appendix Table 15-6. Psychosocial interventions in past year

Males (%)Females (%)18-34 years (%)35-64 years (%)Persons (%)
Counselling, psychotherapy or group therapy
26.0
37.1
30.7
30.4
30.5
Cognitive behavioural therapy
18.1
28.5
24.6
20.6
22.3
Family intervention
11.1
11.8
14.4
9.2
11.4